TimberRidge Challenge Course Request Form

2. 

3. 

5. Organization Name*

   Please put N/A if it doesn't apply

7. First Name*

8. Last Name*

10. Address*

11. City*

12. State*

13. Zip Code*

15. Phone Number*

16. Email Address*

17. Are you a School?

    1. Yes
    2. No

18. What grade are your students?

20. Date Requesting Challenge Course Program*
    Date Requesting Challenge Course Program

    Please fill in the preferred date for a challenge course program.

21. Number of People in Group*

22. What is the age of participants?*

23. Type of Challenge Course Program Requesting*

    1. Low Challenge Course Program (1/2 Day)
    2. Low Challenge Course Program (Full Day)
    3. Low & High Challenge Course Program (Full Day)
    4. Amazing Challenge Program (1/2 day)

    Low programs are ground level to 12 ft in the air and High programs are ground level to 40 ft in the air.

25. How did you hear about our challenge course? *

    1. TimberRidge Website
    2. Johnson County Park and Recreation Website
    3. Friend or Family Referral
    4. Facebook - TImberRidge Page
    5. Attended an event at TimberRidge
    6. Child attended a field trip or summer camp program
27. Notes:

    Add any additional information about your group here.

29. Staff Responding to Email

30. Date Contract Sent
    Date Contract Sent

31. Date Payment Made
    Date Payment Made

    Date Payment Made

Leave This Blank:


34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit Submit and Print

* indicates a required field